Hospitalization Is the Gateway to End-of-Life Planning: How Discharge Support Works in Japan and Five Things Families Should Check Early
When an older family member is admitted to hospital, many people probably think, “Let’s wait until the treatment is over before we think about anything else.” In reality, though, a hospital stay often brings a decline in physical strength and cognitive function, and families frequently have to decide in a short time how the person will live after discharge. In our training textbooks, too, we describe hospitalization as “the real gateway to shukatsu (end-of-life planning)”: the point at which consultations about care, housing and money all begin at once.
Three in four hospital inpatients are 65 or older
According to the Ministry of Health, Labour and Welfare’s Patient Survey (2023), people aged 65 and over accounted for 75.5% of the estimated number of inpatients on the survey day. In addition, just over 10% (11.1%) of inpatients aged 65 and over could be discharged if arrangements to receive them were in place. Securing a place to live after discharge has become a major challenge not only for patients and families but also for hospitals.
Why hospitals push for early discharge
Much acute inpatient care in Japan is paid under a bundled payment system (the DPC system), in which a daily fee is set for each diagnosis and treatment. Once a stay exceeds certain periods, the daily fee drops in stages, so hospitals have a financial reason to promote early discharge.
That is why many hospitals have a discharge support department, such as a regional medical liaison office, where discharge-planning nurses and medical social workers (MSWs) work with patients and families to decide where the patient will live after discharge. If you’re unsure what to do, start by consulting this office.
Five things families should check during the hospital stay
1. The planned discharge date and the person’s physical condition at discharge
Check roughly when discharge is expected and how well the person is likely to be able to walk, eat and use the toilet by then. If the person transfers to a convalescent rehabilitation ward, there is a cap on the length of stay: as a guide, up to 150 days for cerebrovascular disease (180 days in severe cases) and up to 90 days for a hip (femur) fracture. Work backward from the planned discharge date as you prepare.
2. Whether medical procedures are needed, and how often
Check whether any medical procedures will continue after discharge, such as IV drips, suctioning of phlegm, gastrostomy feeding, insulin injections or home oxygen. The type of residence that can accept the person changes greatly depending on what the procedures are, how often and at what times they are needed, and who performs them. Care workers who have completed the required training can perform only certain procedures, such as suctioning and tube feeding; insulin injections are given by nurses and other qualified staff. Whether nursing staff are on duty at night is often the deciding factor in choosing a residence.
3. The status of the application for care-need certification
If the person has not yet been certified as needing long-term care, apply to the municipality as soon as possible. As a rule, the result is notified within 30 days of application. The care level directly affects which services and residences are available, and the costs.
4. Options for where to live after discharge
Will the person return home and use in-home services, continue rehabilitation at a long-term care health facility (rōken), or move into a private nursing home with care or a similar residence? Compare several options based on the person’s wishes and physical condition and the family’s capacity to provide care.
5. Expected costs and how they will be paid
The costs of medical care, long-term care and housing ultimately come down to money. Work out how long pension income and savings can cover the payments, and from whose account they will be paid. If the person’s decision-making capacity has declined, the adult guardianship system may be needed, and it can take several months for a guardian to be appointed.
Avoiding panic over a sudden discharge
Hospitalization comes suddenly. That is exactly why it is important to talk as a family about housing and money while everyone is still well, and, once someone is admitted, to connect with the hospital’s consultation office early. Next Co., Ltd. publishes training textbooks (in Japanese) that systematically cover the consultations that begin with hospital admission and discharge and the practical work of finding a place to live.
This article is a general explanation based on systems and statistics as of October 2026. For individual decisions, please check with medical institutions, government offices and professionals.
This is an English translation of a column originally published in Japanese by Next Co., Ltd.
About Next Co., Ltd. We support companies in Japan’s senior care and end-of-life planning (shukatsu) market through research, business development and training. Our English textbook, Senior End-of-Life Planning Textbook, explains the market from the big picture down to day-to-day practice, including senior housing and care facility placement consulting. See the English edition | Buy on Gumroad | Contact us
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